I think I understand Dr Neil Blumberg's argument vis-a-vis ABO immune complexes being lethal, BUT, basically, I think here we are talking, largely, about giving blood to get people to the hospital before they die, and then giving them the best we can/idealised treatment, rather than trying to give them idealised treatment at the "roadside" (or wherever the life-threatening injury takes place), in order to keep them alive long enough to get to hospital; and there is a big difference between the two.  Certainly, it has been shown that there is a big difference between the way a blunt trauma injury is treated than a sharp trauma injury is treated and, as a consequence, the 1:1:1 red cell/plasma/platelet ratio (or near to that ratio) is not necessarily the best for all incidents.

To a certain extent, I am very glad that 1) I am not a clinician, and so the decision will never be mine (particularly as statistics is a branch of mathematics that is even worse than most other branches of mathematics in what I can either understand or do!), and 2) that I am retired.

The whole thing reminds me of the arguments concerning the use of clotted samples, which were used universally, when it was thought that detecting haemolysis and complement activation was essential, as opposed to the use of EDTA anti-coagulated samples.  There was a huge kick-back against the use of EDTA because antibodies may be missed, but, eventually, the statisticians got involved, and showed us we were talking nonsense, which then allowed us to introduce automation and, as a consequence, transfusion with minimal human intervention (hence fewer mistakes, particularly as machines do not get tired).  However, that does not mean that transfusions are without dangers - particularly in cases involving, for example, anti-Vel and anti-Jka.

It seems to me that, at the moment, "you pays yer money and you takes yer choice!".

As I say, I instinctively have sympathy for Dr Neil Blumberg's viewpoint, but I feel that we still need more evidence.  Meanwhile, I know for a fact that the HEMS in the UK are delivering more live patients to a hospital alive, using packed red cells and tranexamic acid, and these patients are surviving and staying in hospital for shorter periods, and using fewer blood components during their stay than before we used anything - when patients died on the spot.

I have no idea what is best, but there is no doubt that we are doing better than we were.  Dr Neil Blumberg would not have so many patients to determine his statistics (and he may well be correct - don't get me wrong) if it were not for the fact that many more patients are getting to the hospital alive these days.

Our supplier will not rotate WB

Some of the success of WB may be due to the reduction in crystalloid rather than the whole blood itself.  I look forward to more good studies being published.

Our supplier won't rotate WB.  We would have to schedule our shipments for probably every 2 weeks which means the units have only a few days before expiration by the time we get replacements (after accounting for testing days before they can be distributed plus transport time).  Trying to use these up as packed RBCs with only a few days left will likely mean they are given to any blood type. If we stock them on our helicopter they won't be settled when we want to pack them.  I have seen some smaller refrigerated centrifuges that look like they will spin blood units.  Has anyone used a Rotina 420R from Helmer for blood units?